Chamber and committees

NHS boards must ensure that local surveillance mechanisms are in place to identify any potential areas for improvement in infection control practice, and this includes surveillance to link cases of Clostridium difficile to specific hospitals, wards and beds. Whenever a patient is transferred to another area or discharged, the bed and clinical area they occupied undergoes a thorough terminal clean. If the patient was C. diff positive then this would additionally include the use of chlorine based cleaning agents, which are a proven method of killing C. diff spores, to ensure the bed is completely decontaminated and prepared for the next patient to occupy.

The Scottish Government is also making available £2 million to NHS boards in the current financial year to support the further development of robust local surveillance systems, and NHS board practice in this area is the subject of review by the HAI National Taskforce, chaired by the Chief Nursing Officer.

This study is expected to be completed by 31 January 2010.

I have asked Mike Ewart, Chief Executive of the Scottish Prison Service (SPS) to respond. His response is as follows:

All convicted prisoners receive an initial Core Screen interview as part of the Integrated Case Management (ICM) process within 72 hours of admission. This process can highlight specific needs including learning difficulties but relies on self disclosure by the prisoner. The initial Core Screening interview forms the start of the process which can lead to referrals to specialist service providers including education and health care within the prison.

In addition to the Core Screen interview convicted prisoners also complete a literacy alerting tool which can establish if a prisoner has potential literacy learning needs, this may also highlight potential learning difficulties.

In accordance with the SPS Health Care Standard 1, all prisoners have a physical, mental health, and addictions screening on admission to custody. There is no specific health care screening tool in place to identify learning difficulties.

Since my previous answer further progress has been made and at the end of November the number waiting for arrears had come down to 5,534.

To put this into context, the effective date of introduction of Agenda for Change was 1 October 2004. When the current administration took office in May 2007, 124,381 staff had been assimilated and 59% of these had been assessed for arrears with these paid where appropriate. By the end of November 2008, the number assimilated had increased to 175,004 and the percentage who had received payment of arrears had been increased to 93%.

Boards are currently working hard to try to have all substantive staff assimilated by the end of the year. Thereafter, I would expect boards to ensure payment of arrears are processed as early as possible in the new year. Progress will be monitored on a monthly basis.

I have asked Mike Ewart, Chief Executive of the Scottish Prison Service (SPS) to respond. His response is as follows:

Social Enquiry Reports and Trial Judge Reports may make reference to learning difficulty/disability issues. The SPS receive both reports and will follow up this information providing the prisoner consents to information being requested from their GP or other community based providers. Additionally, the SPS relies on prisoners self disclosing diagnosis of learning difficulty.

Where a prisoner is subject to post-release supervision community service providers are involved in the multi-agency Integrated Case Management (ICM) Community Integration Planning (CIP) process. The involvement of community service providers to this planning process facilitates two way communications of relevant information regarding learning difficulties/disabilities between the community and the SPS, including post release information.

In addition discharge summaries are sent to the GP''s where prisoner''s GP information is known and the prisoner wishes such information to be shared. In specific cases of extreme learning difficulty/disability which could affect the prisoner''s return to the community, a Care Programme Approach as used by the NHS may be initiated prior to the prisoner''s release from prison.

The Scottish Government has already undertaken considerable work with businesses to ensure that they are prepared for a flu pandemic. Engagement is continuing on both a Scottish and UK basis with businesses in sectors such as transport and energy.

A Scottish Framework for Responding to an Influenza Pandemic was published by the Scottish Government in 2007 and provides guidance and planning assumptions on which all business continuity plans should be made. The framework is supported by a range of sector-specific guidance, including advice on infection control. The guidance is available on the Scottish Government website at www.scotland.gov.uk/pandemicflu.

Local authorities also have a role in supporting businesses. Under the Civil Contingencies Act, local authorities are required to provide assistance to those undertaking commercial activities and to voluntary organisations in relation to business continuity management. These responsibilities are outlined in the Scottish Government''s guidance on preparing for emergencies Preparing Scotland. The Scottish Government continues to provide support to local authorities in carrying out this role.

The Scottish Centre for Healthy Working Lives provides advice on health promotion and occupational health and safety. Business continuity planning for a flu pandemic does not fall within this remit.

NHS boards are responsible for ensuring they comply with national guidance as set out in the Health Protection Scotland (HPS) protocols for surveillance. NHS board practice in this area is also the subject of review by the HAI National Taskforce, chaired by the Chief Nursing Officer.

All available information on ribotypes is published in the clostridium difficile quarterly reports available through the Health Protection Scotland website at www.hps.scot.nhs.uk.

At present information is only recorded at a national level and is not broken down by Health Board or hospital. Samples from severe cases of CDAD and suspected outbreaks are submitted to the Scottish Reference Laboratory Service for typing.

The Scottish Government has asked Health Protection Scotland to co-ordinate a snapshot study of clostridium difficile ribotypes. This study will start early next year and will involve the typing of representative samples of all cases of C.diff, not just those of severe disease, suspected outbreaks, or suspected infections with ribotype 027. This will give an accurate picture of the epidemiology of C.diff strains in Scotland and will help to inform how the monitoring of strains should take place in future. The results will be made available publicly.

The following is the original answer (published on 15 December 2008); see below.

All available information on ribotypes is published in the clostridium difficile quarterly reports available through the Health Protection Scotland website at www.hps.scot.nhs.uk.

At present information is only recorded at a national level and is not broken down by health board or hospital. Samples from severe cases of CDAD and suspected outbreaks are submitted to the Scottish Reference Laboratory Service for typing.

The Scottish Government has asked Health Protection Scotland to co-ordinate a snapshot study of Clostridium difficile ribotypes. This study will start early next year and will involve the typing of all samples of C.diff, not just those of severe disease, suspected outbreaks, or suspected infections with ribotype 027. This will give an accurate picture of the epidemiology of C.diff strains in Scotland and will help to inform how the monitoring of strains should take place in future. The results will be made available publicly.

National surveillance of Clostridium difficile is carried out at board level although hospitals undertake local surveillance. However, in future there will be a common reporting template used by all boards to capture HAI data at hospital/service level on a number of metrics, for example MRSA, C.diff, Hand Hygiene, cleaning standards and causes of adverse incidents. Prior to October 2006 cases were reported on a voluntary basis and the systems for doing so were unreliable. Therefore only the past seven quarters of data are available. It should also be noted that the first quarter (October 2006 to December 2006) of data collection was artificially low, due to a lack of full compliance with the surveillance protocol by some hospitals.

Table showing C.diff cases for the past seven quarters, broken down by health board:

	October 06 - December 06	January 07 - March 07	April 07 “ June 07	July 07 - September 07	October 07 - December 07	January 08 - March 08	April 08 “ June 08
Ayrshire and Arran	110	151	137	152	113	125	160
Borders	13	13	18	16	20	33	25
Dumfries and Galloway	34	44	53	26	31	47	41
Fife	48	108	73	72	123	134	98
Forth Valley	64	102	54	70	81	120	126
Grampian	119	151	116	103	149	247	226
Greater Glasgow and Clyde	268	472	444	416	421	463	402
Highland	50	64	58	86	81	35	47
Lanarkshire	140	226	194	170	198	251	189
Lothian	241	258	262	212	248	259	261
Orkney	3	0	5	0	5	1	5
Shetland	4	5	2	3	2	4	1
Tayside	108	172	169	131	135	139	145
Western Isles	11	9	3	2	1	3	6
Total	1,213	1,775	1,588	1,459	1,608	1,861	1,732

Source: Health Protection Scotland: www.hps.scot.nhs.uk.

I have asked Mike Ewart, Chief Executive of the Scottish Prison Service to respond. His response is as follows:

There are currently 16 registered learning disability nurses employed by the Scottish Prison Service.

All prison based social workers are qualified social workers. There is currently no specialist learning difficulties qualification for social workers. Training on learning difficulties is incorporated into the generic training for qualified social workers.